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The National Traumatic Occupational Fatalities (NTOF) surveillance system identified machinery-related incidents as the fourth leading cause of traumatic occupational fatalities in the U.S. construction industry between 1980 and 1992, resulting in 1,901 deaths and 2.13 deaths per 100,000 workers. All but 22 of the victims were males. Males had nearly eight times the fatality rate observed among females (2.3 vs. 0.29). The fatality rate in the Northeast census region, 1.29, was considerably lower than the rates in other regions, which ranged from 2.05 to 2.37. Overall, fatality rates declined 50% over the study period. Workers in three occupation divisions - precision production, craft, and repair; transportation and material moving; and handlers, equipment cleaners, helpers, and laborers - had both the highest frequency and rate of fatalities. Cranes, excavating machinery, and tractors were the machines most frequently involved. During the study period, fatality rates for tractors and cranes declined 71% and 67%, respectively, while rates for excavating machinery declined only 12%. The most common incident types were: struck by a mobile machine; overturn; and struck by a boom. Further delineation of groups at highest risk for machinery-related injuries is complicated by a lack of data on exposure to machinery, since exposure is clearly not equivalent across all occupational groups within the construction industry. The findings suggest that injury prevention programs should focus not only on machine operators, but on those who work on foot around machines. Translation of regulations into "plain English," providing incentives for safe work practices, and addressing safety in project planning stages can also help to reduce machinery-related deaths in construction.